Association between stillbirth and illicit drug use and smoking during pregnancy

Michael W. Varner, Robert M. Silver, Carol J Rowland Hogue, Marian Willinger, Corette B. Parker, Vanessa R. Thorsten, Robert L. Goldenberg, George Saade, Donald J. Dudley, Donald Coustan, Barbara Stoll, Radek Bukowski, Matthew A. Koch, Deborah Conway, Halit Pinar, Uma M. Reddy

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

OBJECTIVE: To compare illicit drug and smoking use in pregnancies with and without stillbirth. METHODS: The Stillbirth Collaborative Research Network conducted a case-control study from March 2006 to September 2008, covering more than 90% of deliveries to residents of five a priori-defined geographically diverse regions. The study attempted to include all stillbirths and representative liveborn controls. Umbilical cord samples from cases and controls were collected and frozen for subsequent batch analysis. Maternal serum was collected at delivery and batch analyzed for cotinine. RESULTS: For 663 stillbirth deliveries, 418 (63%) had cord homogenate and 579 (87%) had maternal cotinine assays performed. For 1,932 live birth deliveries, 1,050 (54%) had cord homogenate toxicology and 1,545 (80%) had maternal cotinine assays performed. A positive cord homogenate test for any illicit drug was associated with stillbirth (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.16-3.27). The most common individual drug was cannabis (OR 2.34 95% CI 1.13-4.81), although the effect was partially confounded by smoking. Both maternal selfreported smoking history and maternal serum cotinine levels were associated in a dose-response relationship with stillbirth. Positive serum cotinine less than 3 ng/mL and no reported history of smoking (proxy for passive smoke exposure) also were associated with stillbirth (OR 2.06, 95% CI 1.24-3.41). CONCLUSION: Cannabis use, smoking, illicit drug use, and apparent exposure to second-hand smoke, separately or in combination, during pregnancy were associated with an increased risk of stillbirth. Because cannabis use may be increasing with increased legalization, the relevance of these findings may increase as well.

Original languageEnglish (US)
Pages (from-to)113-125
Number of pages13
JournalObstetrics and Gynecology
Volume123
Issue number1
DOIs
StatePublished - 2014

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Stillbirth
Street Drugs
Cotinine
Smoking
Pregnancy
Mothers
Tobacco Smoke Pollution
Odds Ratio
Confidence Intervals
Cannabis
Serum
Marijuana Smoking
Umbilical Cord
Live Birth
Proxy
Smoke
Toxicology
Case-Control Studies
History
Research

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Varner, M. W., Silver, R. M., Hogue, C. J. R., Willinger, M., Parker, C. B., Thorsten, V. R., ... Reddy, U. M. (2014). Association between stillbirth and illicit drug use and smoking during pregnancy. Obstetrics and Gynecology, 123(1), 113-125. https://doi.org/10.1097/AOG.0000000000000052

Association between stillbirth and illicit drug use and smoking during pregnancy. / Varner, Michael W.; Silver, Robert M.; Hogue, Carol J Rowland; Willinger, Marian; Parker, Corette B.; Thorsten, Vanessa R.; Goldenberg, Robert L.; Saade, George; Dudley, Donald J.; Coustan, Donald; Stoll, Barbara; Bukowski, Radek; Koch, Matthew A.; Conway, Deborah; Pinar, Halit; Reddy, Uma M.

In: Obstetrics and Gynecology, Vol. 123, No. 1, 2014, p. 113-125.

Research output: Contribution to journalArticle

Varner, MW, Silver, RM, Hogue, CJR, Willinger, M, Parker, CB, Thorsten, VR, Goldenberg, RL, Saade, G, Dudley, DJ, Coustan, D, Stoll, B, Bukowski, R, Koch, MA, Conway, D, Pinar, H & Reddy, UM 2014, 'Association between stillbirth and illicit drug use and smoking during pregnancy', Obstetrics and Gynecology, vol. 123, no. 1, pp. 113-125. https://doi.org/10.1097/AOG.0000000000000052
Varner MW, Silver RM, Hogue CJR, Willinger M, Parker CB, Thorsten VR et al. Association between stillbirth and illicit drug use and smoking during pregnancy. Obstetrics and Gynecology. 2014;123(1):113-125. https://doi.org/10.1097/AOG.0000000000000052
Varner, Michael W. ; Silver, Robert M. ; Hogue, Carol J Rowland ; Willinger, Marian ; Parker, Corette B. ; Thorsten, Vanessa R. ; Goldenberg, Robert L. ; Saade, George ; Dudley, Donald J. ; Coustan, Donald ; Stoll, Barbara ; Bukowski, Radek ; Koch, Matthew A. ; Conway, Deborah ; Pinar, Halit ; Reddy, Uma M. / Association between stillbirth and illicit drug use and smoking during pregnancy. In: Obstetrics and Gynecology. 2014 ; Vol. 123, No. 1. pp. 113-125.
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abstract = "OBJECTIVE: To compare illicit drug and smoking use in pregnancies with and without stillbirth. METHODS: The Stillbirth Collaborative Research Network conducted a case-control study from March 2006 to September 2008, covering more than 90{\%} of deliveries to residents of five a priori-defined geographically diverse regions. The study attempted to include all stillbirths and representative liveborn controls. Umbilical cord samples from cases and controls were collected and frozen for subsequent batch analysis. Maternal serum was collected at delivery and batch analyzed for cotinine. RESULTS: For 663 stillbirth deliveries, 418 (63{\%}) had cord homogenate and 579 (87{\%}) had maternal cotinine assays performed. For 1,932 live birth deliveries, 1,050 (54{\%}) had cord homogenate toxicology and 1,545 (80{\%}) had maternal cotinine assays performed. A positive cord homogenate test for any illicit drug was associated with stillbirth (odds ratio [OR] 1.94, 95{\%} confidence interval [CI] 1.16-3.27). The most common individual drug was cannabis (OR 2.34 95{\%} CI 1.13-4.81), although the effect was partially confounded by smoking. Both maternal selfreported smoking history and maternal serum cotinine levels were associated in a dose-response relationship with stillbirth. Positive serum cotinine less than 3 ng/mL and no reported history of smoking (proxy for passive smoke exposure) also were associated with stillbirth (OR 2.06, 95{\%} CI 1.24-3.41). CONCLUSION: Cannabis use, smoking, illicit drug use, and apparent exposure to second-hand smoke, separately or in combination, during pregnancy were associated with an increased risk of stillbirth. Because cannabis use may be increasing with increased legalization, the relevance of these findings may increase as well.",
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AU - Varner, Michael W.

AU - Silver, Robert M.

AU - Hogue, Carol J Rowland

AU - Willinger, Marian

AU - Parker, Corette B.

AU - Thorsten, Vanessa R.

AU - Goldenberg, Robert L.

AU - Saade, George

AU - Dudley, Donald J.

AU - Coustan, Donald

AU - Stoll, Barbara

AU - Bukowski, Radek

AU - Koch, Matthew A.

AU - Conway, Deborah

AU - Pinar, Halit

AU - Reddy, Uma M.

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N2 - OBJECTIVE: To compare illicit drug and smoking use in pregnancies with and without stillbirth. METHODS: The Stillbirth Collaborative Research Network conducted a case-control study from March 2006 to September 2008, covering more than 90% of deliveries to residents of five a priori-defined geographically diverse regions. The study attempted to include all stillbirths and representative liveborn controls. Umbilical cord samples from cases and controls were collected and frozen for subsequent batch analysis. Maternal serum was collected at delivery and batch analyzed for cotinine. RESULTS: For 663 stillbirth deliveries, 418 (63%) had cord homogenate and 579 (87%) had maternal cotinine assays performed. For 1,932 live birth deliveries, 1,050 (54%) had cord homogenate toxicology and 1,545 (80%) had maternal cotinine assays performed. A positive cord homogenate test for any illicit drug was associated with stillbirth (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.16-3.27). The most common individual drug was cannabis (OR 2.34 95% CI 1.13-4.81), although the effect was partially confounded by smoking. Both maternal selfreported smoking history and maternal serum cotinine levels were associated in a dose-response relationship with stillbirth. Positive serum cotinine less than 3 ng/mL and no reported history of smoking (proxy for passive smoke exposure) also were associated with stillbirth (OR 2.06, 95% CI 1.24-3.41). CONCLUSION: Cannabis use, smoking, illicit drug use, and apparent exposure to second-hand smoke, separately or in combination, during pregnancy were associated with an increased risk of stillbirth. Because cannabis use may be increasing with increased legalization, the relevance of these findings may increase as well.

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